E100 The Advice Episode
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Chad Ball 00:03
Welcome to the Cold Steel surgical podcast with your hosts Ameer Farooq and Chad Ball. Well Ameer, this is a real special episode. It's our 100th and I can't believe that we're here. It's kind of crazy, eh?
Ameer Farooq 00:15
It is wild.
Chad Ball 00:17
I was thinking back to the Genesis on this special issue of the podcast in general. And obviously, you know, I think our goals together were to try and get at more than academic and even clinical medicine with all these surgeons that we've had the privilege of interviewing. Talking about personal life and goals and maybe even methodologies for achieving better lives. What do you think was the initial Genesis?
Ameer Farooq 00:42
When we really thought of this on that call shift many months, or almost years ago now, in my mind, I had really thought of this as being very much a didactic content driven type podcast. I thought, you know, we'll highlight the articles from the Canadian Journal Surgery, we will highlight different things, CME type topics, resident type topics, pick the things that I think aren't explained well, and really have it very surgically driven, very content oriented, that type of thing. But I really like the way that the podcast has evolved, I really have enjoyed so many of the things that our guests have talked about that have nothing to do, I shouldn't say nothing to do, because arguably a lot of the mastery type things like Dan Van Hooren talks about in basketball, really applied it to surgery. But I just have really enjoyed the way that the podcast has gone. And I learned so much from all the different forays and different things that we've gone into.
Chad Ball 01:46
I think you hit the nail on the head, you know, the genesis of the podcast is one thing, but the voyage is really another and I think, you know, a lot of us listen to a lot of different podcasts and come and go from those particular shows over the months and over the years. But I think you'd probably agree, hey, that when you listen to a podcast in a serial sort of longer way, you see, and you hear, I guess more accurately, the guests change. And the amount, as you said, that I've learned personally from all of these amazing guests we've had is, it's really incredible. It's an education like no other.
Ameer Farooq 02:23
It's funny how many of our guests, I found, had similar outlooks on life or similar principles in the way that they were driven. Like, you know, listening to the episodes again, for our 100th episode, you really start to see some commonalities. And for me, one of the big things that I felt like I took away from listening to all these episodes, again, was just the love of the craft, regardless of whether it was a surgeon that we interviewed or Shane DiNapoli, or whoever it was. You know, people who love their craft - that shines through. And it is infectious, and it just permeates everything that they touch.
Chad Ball 03:06
Right. That's well said. You know, it's also interesting to me that despite some of those common threads and similar themes, I think we all individually pull or highlight different things from each conversation and each guest. What I think of as significant going forward, and what rolls around in my mind may be something very different than you, for example, eh?
Ameer Farooq 03:25
Yeah, absolutely. I think that's one of the neat things of having worked on this with you is what you and I take away from each episode. And what we really, sometimes get highlighted for each episode can be very different.
Chad Ball 03:39
I think it's important to highlight the guests themselves, you know. Not only their insight and their skill, but more importantly, their generosity. I'm sure our listeners probably know this. But you know, we don't we don't pay these guests. This is a nonprofit operation here, with really no funding and they do it out of the generosity of their hearts. And you know, as usual, as you know, the busiest people are usually the easiest to schedule and the most keen to come on, true to regular life as well. But really, the guests and the talent are what obviously drives the show. And we've been so lucky to have.
Ameer Farooq 04:15
Yeah, and again, what a lot of listeners may not know is that sometimes our guests are getting up at ungodly hours of the day or the night to come and join us simply because they just love what they're doing. And they're so generous with their time, as you said, Dr. Ball.
Chad Ball 04:32
I want to talk just briefly about the future of the podcast and where we're going. So obviously, we have an incredible list of new guests coming up, but also some new formats. I think one of the things that we'll try is some conference-based episodes with different styles. So, you know, we're looking for feedback on that as we go forward. We're really going global. Also, masterclasses and some softer topics as well.
Ameer Farooq 04:56
Yeah, I'm hoping that we can really continue to expand on some of the content that we have so far. Hopefully some more mock orals because I think people found that helpful. And yeah, just continue to build out the episodes.
Chad Ball 05:10
That's awesome. I can't imagine a better partner and person could be on this voyage with. So, you are the heart of it. And I look forward to the next year with you.
Ameer Farooq 05:18
The pleasure has been all mine.
Chad Ball 05:20
I can't believe we're at 100 episodes, and I don't think either of us probably thought we would get here. We're so excited to present this 100th episode to the listeners. And what we've tried to do is create a compilation that surrounds really the question that you are I ask at the end of the podcast typically, which is, if you could go back as the guest to a younger version of yourself, what would you wish you had known? Or what advice would you give yourself?
Ameer Farooq 05:44
And we really have to give credit to one of our newest members on the Cold Steel team. And that's Tyler Daniels. Tyler Daniels is a student at Mount Royal University. And he himself has an interesting backstory, which hopefully we'll get him to tell on the podcast one of these days. But Tyler Daniels is in the media stream at Mount Royal University and has put together this 100th episodes mix, so to speak. So, sit back and enjoy our 100th episode of Cold Steel.
Morad Hameed 06:23
Our unique perspectives and passions and background are actually the source of our success as surgeons and teachers and researchers. And so, whatever it is that, you know, motivates you and inspires you. It's important, I think, to bring it forward into the discipline, and in so doing to move our discipline forward. So, for example, one of my colleagues told me that she wanted to work on climate change, or another told me that she wanted to mentor high school students to pursue careers in science and medicine. So, the possibilities are, just by those two examples, they're endless. And I think it's, as I said before, it's our duty to ensure that we all pursue these possibilities and support each other to reach our full potential.
Sav Brar 07:18
A great lesson for all of us that if you have interests outside of medicine, you shouldn't be shy about pursuing them. And ultimately, not that everyone needs to be creative to be a great surgeon, I actually disagree with that conclusion. Sometimes the people make from his example. There's many surgeons who just did surgery, but did it amazing. I just don't think that you need to leave your life outside of medicine. At home, when you embark on this, like journey of becoming a surgeon.
Chad Ball 07:49
I couldn't agree more. And sometimes when one of those aspects of your life is a little slow, the other picks it up and keeps you moving back.
Sav Brar 07:59
Yeah, I think that's a great, great point. And I don't know what the evidence for that is, I think definitely... like if you have a hobby or an interest outside of medicine, not even a hobby, like another side gig or a side hustle that comes with that and it's going well, it helps your day job or your dream job.
Tony Gomes 08:19
I think it's important to relish in your successes, because there's plenty of those. Most of us have lots of good outcomes. And I mean, I might sound old, but it goes really, I'm not finished yet. But it goes by in a flash. So, I think you know, like Ferris Bueller said, Life moves pretty fast. Sometimes, you better stop, look around once in a while, or you'll miss it.
Kelly Vogt 08:46
And the second you said not to talk about mentors, but I think it's really important to recognize that I wouldn't be where I am without people like Chad, who have helped me along the way. Find people who love what you love, and they will be so thrilled to capitalize on your enthusiasm for it and help you along the way. Even if Chad's not writing the papers for me, the fact that he supports my ideas and I can bounce things off of him or he can give me advice, has helped me more than probably anything else in my career. So, working with people who are like-minded, who have the same vision and same goals that you do, will make work not only fun, but so much easier.
Andy Kirkpatrick 09:26
When there's an opportunity to learn, grab it. When there's an opportunity for research, grab it. Even if it doesn't fit, but if it's you know, that's your... you can work on a passionate project now when it doesn't really fit into your life versus wait until three months for the block and then you've lost that opportunity. Be an opportunist in killing three birds with one stone. Combining your passions and working. And I think, working with people who you click with, that click with you, that empower you, even if they're in another continent, you know. in this day in age, where we text the people in the office next to us anyways. Don't let geography hold you back.
Tony MacLean 10:26
Probably the most important thing to me is finding the things that you're interested in. That you truly want to do and do them to the best of your ability. And I think people appreciate it.
Neil Parry 10:40
As you know, more senior surgeons go along. I think it's, you know, certainly in my mind, I think it's our duty to be able to mentor younger colleagues. And again, whether we do this formally or informally. It's debatable, but that's what I would look for.
Emily Joos 11:02
That's a good question. And we all often get that question, especially in, for example, info sessions for Red Cross MSF. But what I would tell general surgery trainees, I think, what the number one thing they should focus on is: be excellent surgeons. And that's, I can't say that enough. And I try to tell all my trainees that every day. At the end of the day, what you want to do is do a really good job at what you do, and be excellent at what you do, no matter how you're going to turn this around. Like, it doesn't matter where you work, or how many people you're going to touch or you know, how many papers you publish, you really have to be good at what you do. And otherwise, you really will not have a good impact. So, I think surgical training is extremely difficult and it's not that long when you think about it, it's only five years. So, I'd really tell them to try to really focus on that aspect of it and make sure that when they finish, they can actually be the best that they can be. And of course, you grow, you keep learning, you learn every day. But I think this is a privileged moment for you to develop those skills while being supervised by excellent surgeons. And that's a huge opportunity not to be wasted on being distracted with other things. So that being said, I think it's also important to try to learn about global surgery, in general, and mostly global health and how that world works. And to me, that was very difficult, because I did it later. I did a master's after I finished my training and to learn about the intricacies of global health, which is still very complex to me. But I think trying to get a sense of like, what's out there, how humanitarian work functions, the WHO and all those UN organizations, I think it's important because if you're going to do meaningful work in that domain, you need to understand the intricacies of that completely different world that we're never exposed to. In terms of deployments, like during residency, I did nothing. I just really focused on my training 100%. Like, as I said, I really just wanted to be a good surgeon. So, I didn't go anywhere. And I wouldn't think it's that important nor very useful to actually do deployment on your resume, because you're not the best surgeon that you can be at that point. So, I think you really have to focus primarily on that. But getting to know things about global health, like I said, and just trying to build up on your knowledge.
Ameer Farooq 13:25
If you could go back in time and give yourself advice, perhaps as an early attending, having gone through what you've gone through now, what would the advice be to yourself as maybe an early attending?
Martin Schreiber 13:36
You know, it's the advice I give. I think, you know, at heart, we are all surgeons. We went through surgical residencies, and we are surgeons. Tackle the tough cases. You know, don't avoid anything. Once you start to avoid cases, what happens is, you know, before you know it, you're afraid to do a hernia or an appy. So, get embroiled, take on tough cases, use your partners. Take advice from them, and balance your life. You know, maintain some kind of balance in your life, take care of yourself, take care of your family, develop balance and pick an environment to work in, where you feel part of a family. That is a very healthy environment. Supportive. Will help you through those tough cases and help you achieve your career goals, regardless of what those are. So, make sure if you want to do research, make sure you're in an environment that supports it. But do not shy away from the tough cases. Take them on, get busy. Get your hands working. Those first few years out of training play a big role on who you're going to be. And if you're not really, you know embroiled in surgery then it's possible that you'll shy away from it in the future, and you'll lose your identity as a surgeon.
Husein Moloo 15:11
Make sure every year, you do one new thing. And he's like, it doesn't have to be, doesn't have to be surgical. You know? It doesn't need to be like, gain a new surgical technique. But he's like, do one new thing every year. And that will, again, sustain you and keep you from getting bored. And man, I have really conscientiously tried to do that. And I would say that out of almost anything is really, it's really kept things interesting for me. And so, one new thing every year.
Michael Rosen 15:51
Be collaborative. Be confident enough to listen to others, be thoughtful enough to be introspective, and wonder if maybe they're right. And you know, you don't have all the answers. And finally, just because something works in the short term, doesn't mean it's a good idea in the long term. So, take your time before you think you've figured it all out. Because I certainly liked, as I mentioned at the beginning, I like to live my life on extremes. And I like to be definitive about everything I do. And one of the things that of doing higher quality research and having the courage to ask some of these questions, and the answer to them I was not anticipating. This kind of coping with that and understanding that really is a good thing. But it takes kind of confidence to be able to be collaborative and be open minded in that.
Wayne Rosen 16:46
You know, I've thought about this question, because I've heard you ask it to several of your previous participants. And, you know, I would tell myself, to do exactly what I wanted to do. To be passionate about the topics. You know, although I did at one point think I could be research, I realized that it really wasn't my bailiwick, and that, you know, my area of expertise, that any contributions I was going to make, were going to be in the area of bioethics or some of my other talks that you guys have alluded to today. And so, I would say, I would probably pursue even more. Be true to yourself, or myself, and pursue those areas.
Matt Kaminsky 17:33
Always to be true to yourself. I know that sounds very cliche, but occasionally you'll see residents focusing on a specialty. And I think that they like the people that are in that specialty, but they may not. It appears that they may not really, really be passionate about that area. So, just be cognizant of that. So, residents should always be really focused on what they enjoy on a day-to-day basis, whatever that may be. And that could be very bread and butter, general surgery and/or rural surgery. It could be on the critical care side, it could be brass, whatever it is. To ask yourself: do I really enjoy this? And I really want it. And I think residents, if they focus on an area that they really find easy or enjoyable, to capitalize on that. You don't have to be anything in particular.
Paul Greigg 18:45
Anyone at any stage who was aligned with the great John Tarpley still probably says, "Get in the habit of having good habits". Which means, you know, whether it's tying a stitch, you always drive your finger down to secure the knot flat and do everything rather than get in the bad habit of doing it when it's maybe not as important. Because if you don't have that tendency to have good habits, when it is important, you may make a mistake.
Rebecca Auer 19:19
And I guess the other thing would be that... a lot of people talk about work life balance, and I have decided that that doesn't exist for me. First of all, I don't think that balance is achievable. Balance would suggest that you have some equity between those things. And the other thing is it suggests that work is not part of your life. When, as most of us as surgeons, work is a huge part of our life. It's part of our identity for many people. And that's not to say that we aren't anything else, but it is a huge part of who I am and what makes me, me. And I think that's okay. So, I prefer to say there's more calm harmony. And sometimes that harmony is completely off, and my kids really will make sure I know it when it is.
Richard Reznick 20:07
What we've seen in the last 30 years is a fundamental change to the way we teach surgery. And so, with that fundamental change, what we've tried to do in the last 20 years to react is skirt around the edges, as opposed to really cut to the center of what the problem is. And to me, at that very core, is making the most of every last training moment, and making sure that we make every single moment the very best we can. And making sure that our trainees are accomplishing the goals that we set out for them, which involves much more comprehensive assessment. So, I'm confident that the next generations of surgeons are like, we have only one dream, right? You do Chad, I do. And that's that the next generation of surgeons can't be just as good as you are. They can't. If they're just as good as you are, we'll have failed.
Rebecca Auer 21:11
In fact, this COVID thing has really made me realize how much of a village my world has, and how I'm missing my village so much these days. Because we've been so blessed with having so many people in our lives that help out.
Tim Pawlik 21:25
And then as far as societies are concerned, you know, I'm kind of, you know, I don't want to be a too self-serving here. But I would have to say, you know, one would be the Association for Academic Surgery, especially for young people. That society is specifically focused on young surgeons, and there's lots of opportunity for young surgeons to get involved and quickly move into leadership positions in the AAS. And one of the other benefits of the AAS is discipline agnostic or very ecumenical. So, it is a great way to get to know people in other disciplines. And then as your career matures, and their career matures, you have a wide network of individuals in surgery with large beyond HPB. I would also recommend that you get involved in the HPBA. The HPBA is the premier HPB surgical Association in Canada, North America, Central America and South America, and has a number of rich opportunities with regards to mentorship, leadership, and the ability to present your work, get to know people, create collaborations, and really advance your career.
David Feliciano 22:47
I did learn to go up to people at meetings and say, you know, I really admire your work. And I just have a few questions. And by doing that, you know, I got to meet some really great people from all over the world. And I got some really great advice. And then they knew my name. And then I was interested in their field. So, I would not be bashful. I tell fellows this all the time, they never listen. If you see Jean Moore in a meeting and you have some issue or you know, academic or career wise or whatever, he can find the time. You just have to approach a person like that: appropriately and say what I said. I met Leon Pachter at New York University on a tennis court. I went up to him, I said, I have read all your papers. And I said, I just love them. And he is now you know, all these years later, it's 38 years later, we're close friends. And that kind of contact really helps you. So, a big one is branch out, make good contacts in your field. It'll be mutually beneficial over time.
Alex Poole 23:59
That's a good question. I think, to have this sort of practice, it'd be hard to live in an academic center. So, I think first you'd have to want to live in an area in either the north or more remotely in the south. And then, I would just follow your passion. You have to really enjoy what you're doing, get as broad based in education as you can. And even if you don't have rotations. Like I'm not sure they do plastics rotations, or neurosurgery rotations or orthopedic rotations, or general internal medicine, which were all invaluable to me and I use many of them daily, if not weekly. You can ask questions, you can be interested, you can poke your head into a case and see what's going on and it'll build from there. And if you're interested, there certainly are ways of designing your practice to get continuing medical education. Before you return Chad. I took a month, and I hadn't operated on a liver trauma for a long time. So, I just hung out in Calgary and scrubbed on hepatobiliary cases for a month a few years back. And just little things like that to pick up your experience and skill set is invaluable. So, I think if you're interested in what you're doing and you want to live in a smaller area, then I'm sure it can still be done.
Charles Vollmer 24:54
It's been to come to something at the end of that paper or the end of the project or the presentation you give, you got to come to something that offers a path forward. And the one thing I always say to my scholars is, you know, have the next paper in mind when you're writing your current paper. And if you're really good, you're going to foreshadow what that next paper what the moves will be in that next paper, in, you know, sort of your discussion and conclusion area. And sort of like a chess game, you're always looking ahead. Be ahead of the rest of the field. And if you are, you will get published.
Christian Finley 26:03
Good trainers. Like to ask around and really do your due diligence to find out a place you want to train. And then I would go all in. I think that by committing yourself to the undertaking of surgery, with your heart, you can come out of it with a wonderful career. You know, I love my job. And I think part of that is because I really took all the opportunities that came my way and may have created a few for myself, but most of it was just working hard, and enjoying it. And I think that that's what makes it a great job. Like, you know, when you ask surgeons about their quality of life, even into later the years of practice, they love it. You know, when I think of myself in my CPAC job, you know, I still am a surgeon four days a week and I've looked at other opportunities. And I sit back and go I love being a surgeon. You know, it's the best job ever. And so, I think by being a surgeon and getting a good training and sort of savoring the experience of it is wonderful. It's, you know... I'm a third-generation thoracic surgeon. When I read my grandfather's operative report from 1945, I can sense his joy, his terror in doing you know, that first pneumonectomy. You can read through his operative report and go and try to think back to doing a pneumonectomy when no one knew how to do a pneumonectomy. And doing an MIS coli when you haven't done one before. It's a great job with lots of challenges and rewards and sorrow, but my recommendation would be to enjoy it. Because it is fleeting.
Andrew Furey 27:51
I think, you know, the take home lesson for residency for me, if someone could have articulated perhaps a bit better was that the exam at the end is only the beginning. So, you know, don't put too much pressure on yourself for the exam. I mean, of course you want to pass but really the true education begins after you start. Because there is a whole other series of pressures and concerns when it is your patient, your practice. That isn't captured by any sort of examination process. And I think the shock of that for me a little bit, and I think it's probably true for all surgeons, if you're being honest. It was a little bit more than I would have thought. So that would be one thing. The other thing I would say, again, it's the same thing, but it's just the start. And you can do all kinds of incredible things once you're finished. I think you feel like you're in a silo, you're so concentrated on the subspecialty or the specialty. But medicine has incredible opportunities beyond the walls of the hospital. And you just got to keep your eyes open, keep looking for them. Whether it's, you know, being involved in global medicine or your local community or giving back.
Janice Pasieka 29:21
And I think the one thing that I didn't do early in my career, but I'm certainly doing more and more as I "mature". And that is I go out of my way to try to learn one thing every day from a patient. And I'm not talking always about some new diagnosis or something in medicine, but to spend the time and get to, you know, find out a little bit about them and learn something new every day.
Rick Buckley 29:53
They really should be active in trying to find something that really turns them on, but within medicine, you have to have a turn off switch. And then you have to have something that really turns you on outside medicine. Now, I'm convinced that everybody needs a family around them. And that's a given. But you need something other than your family and other than your clinical medicine side because it's just good for you. It's healthy. And that combined with fitness. God don't forget your fitness. When you combine all those things, you've got your family, your fitness, your work and your special things, you really got the full life then.
Vahagn Nikolian 30:34
One of the pieces of advice that my mentors gave me that really changed my perspective and made me a better doctor and surgeon and person was not to get too high on the highs and not to get too low on the lows.
Andrew Ibrahim 30:49
I think I'd tell myself just to be kinder to myself. I think the second part I would tell myself is it's okay to take risk. And that a lot of these ideas I had, even younger than now. And I sort of was shy about developing them because I thought it was too risky or like, who's ever going to get excited about that? Or who's going to care about those ideas? Well, it turns out a lot of people care about those ideas. And part of me was like, well, maybe I should have developed that sooner. And so, I think being kind to yourself and taking some more risks.
Jillian Horton 31:25
A strong sense of what our meaning and purpose is. And what our connection is to that meaning and purpose through the work that we do is one of the things that gives us relief from burnout. And one of the things that continues to make our work feel more like a calling than a job.
Melissa Red Hoffman 31:43
Ah, I'd say girl, you're enough. Keep shining bright, keeps showing up. I just have a hard time showing up. Just like, show up. That's where the magic happens. I have found that in my life, so much magic has happened for me in the last couple years because I've just shown up. I just invited myself to the table. And then once you're there, people just assume you're supposed to be there. And I wish I knew that when I was younger. I was always just so anxious, didn't want to step on toes, felt shy and you just got to push through it, you know. So, I think that's what I'd say. And then there used to be a lot of angst around me in residency wearing glitter eyeshadow, which I never stopped wearing.
Ameer Farooq 32:40
You've been listening to Cold Steel, the official podcast of the Canadian Journal of Surgery. This podcast was edited and produced by Tyler Daniels. If you've liked what you've been listening to, please leave us a review on iTunes. We'd love to hear your comments and feedback. So, feel free to email us at [email protected] or connect with us on Twitter @CanJSurg. Thanks again.